Did you know that up to 50 per cent of infertility is caused by the male? (1, 2) That’s half, which makes sense, right? Especially with it taking ‘two to tango’.

So… why is men’s infertility not widely talked about?

The ‘journey’ often only focuses on and talks about the women’s eggs and what she needs to go through.

It’s a topic that isn’t really talked about at the dinner table or out at the pub with mates, but fortunately it’s a topic that is slowly making gains in public awareness, and will only become more wildly known and accepted when talked about.

I’ve seen countless cases where the female and couple have been subdued to so many countless rounds of IUI or IVF, with no tests or assessments performed on the male sperm, only to find out after many $$ and years later that the sperm was a huge or only contributing factor.

Fortunately, the information we now know and availability of tests and reproductive assistance has improved greatly in the last few decades, which gives us lots to be positive about.

Okay, so what do the numbers tell us?

Did you know that in the last 30+ years, the sperm quality has decreased dramatically? The reference ranges for Australian standards have also changed drastically in this period (in total count, morphology and motility of sperm).

For example, before the year 2000, the reference range of morphology (such as normal head, tails and forms) used to be approximately 30% normal; from 2015 onwards it has been 4%.

Before year 2000, motility levels (sperm’s forward movement) were 75%; now it’s 40% (3). That is, now the so-called “normal” reference ranges mean that only 40% of the total sperm are moving forward and only 4% of your ejaculated sperm are normal in shape. Did I say 4%… Yes!

No wonder the chances of getting pregnant each month are so low!

Why have the ranges changed so dramatically? Aside from the fact modern sperm analysis techniques/classifications have changed, and analysis can be quite subjective; there are links to environmental and lifestyle factors, which I”ll talk about further.

Firstly, consult with your GP/ fertility specialist:

Don’t be hesitant! When I speak to males, some feel that sperm results may reflect upon their ‘man-hood/ manliness’ and delay any investigations in fear of potential results.

Truth is, I feel it’s much more admirable for those males that are proactive in their own health and their fertility, and want to work together to help get the best outcomes for them and their partner.

What would you expect in a consult?

Thorough medical history intake (sexual history, medical and medicinal history (including use of testosterone, anabolic steroids, transmitted diseases), lifestyle and radiation/ chemical exposure factors).
Physical genital exam of all the goods! (this will include the penis, testes size, scrotum, epididymis, presence of vas deferens and checking for the presence of any varicoceles.
Semen/ sperm analysis - if there are unusual parameters, a repeat analysis is suggested 1-3 months later. Ensure abstinence of ejaculation 2-5 days prior, no spillage during the sample and that the sample testing time <1hour.
Endocrine hormone blood tests (including serum and free testosterone, hormones including FSH and LH and others if indicated.
Genetic testing only if warranted.

Causes of male infertility

Below is a list of some causes; most will need to be assessed and diagnosed via your fertility specialist.

Congential reasons - hormonal, genetic, structural (eg maldescent of testes).

Acquired reasons - tumours, inflammatory, trauma, iatrogenic (caused by a medical or drug complication), certain medical conditions (eg morbid obesity, liver disease, haemochromatosis, diabetes mellitus). Structural anomalies (eg varicocele), infections (eg mumps, chlamydia, gonorrhoea) and environmental exposures which I will discuss further below.

Erection dysfunction can be caused from a complex range of factors, including genetic, hormonal, drugs, psychological, neurological, blood supply or structural issues.

Ejaculation dysfunction or retrograde ejaculation (where it passes back into the bladder, so only a small amount of ejaculate is emitted) - causes can be due to complications of surgery, drugs and neurological conditions.

Factors that potentially impact your chances and what you can do:

All these following factors are recognised as having impacts to sperm oxidative stress levels, production of sperm and/ or the hormonal pathway (known as the HPG axis) for optimal male fertility:

Psychological stress - the stresses of fertility, relationship stress, and external stresses all have direct impacts on your fertility. With the focus often on the female’s journey and their emotional wellbeing, the male counterpart is often forgotten about, or not discussed. Common feelings often include depression, anxiety, inadequacy and/or guilt (4). Ensure you have the right support around you that can talk to- your closest friends/family, counsellor (if you’re part of a fertility centre, many include this as a complementary service) or psychologist.

Increased body mass index (BMI) and smoking - there is reasonable positive correlation linking increased risks of poor sperm parameters and diminished or nil sperm production (4), increased sperm DNA fragmentation, decreased testosterone and oxidative stress. Smoking effects appears to be dose-dependent (especially for those smoking >20/day), however should be aimed to be minimised (5,6) as even 1 smoke/day has been associated with increased coronary heart disease (7). Increased physical activity, diet modification, and weight loss are all shown to improve semen quality. Added help via a dietitian, nutritionist, and professional to assist with smoking cessation are all available options.

Excessive alcohol consumption and cannabis/ recreational drug use should all be minimised (6)
Exposure to endocrine-disrupting chemicals (EDC’s) and seminal oxidative stress levels - there seems to be some growing and strong links with impacts to sperm quality and in-utero fetal development/growth (and likewise PCOS and endometriosis for women!) however further quality research needs to done to be more specific and conclusive. These EDC’s include pesticides, BPA’s (a chemical found in common hard plastics), parabens and phthlalates (often found in personal care products), metals (eg lead, cadmium, mercury) and solvents (in some cleaning products) (8, 9).

Once these changes have been made, do note that it will take a minimum of 2.5-3 months before potentially seeing a change in sperm tests and quality as it takes at least 74days for a full cycle of sperm to regenerate.

Traditional Chinese Medicine (TCM) and acupuncture

Ever considered having traditional acupuncture or Chinese medicine?

The acupuncturists here at our Prospect clinic have seen many fertility patients, male and female, and are qualified to help with all your fertility needs.

A usual initial appointment would consist of a very thorough intake of medical history, current symptoms, management, and then an individualised diagnosis from a Chinese medicine view, and tailored treatment plan including acupuncture, dietary and lifestyle tips to assist.

We are happy to see you if you’ve just started thinking of improving your fertility or general health, decreasing stress levels and also in conjunction with your partner.

We also work with your fertility specialist/ clinic if you are currently in cycles of IUI/IVF/ICSI.

Current research deems having combination treatment of acupuncture and conventional western medicine as having greater efficacy on male fertility, with acupuncture having very few side effects or adverse effects and comparative low costs. (10)

TCM also views the whole body globally so aims to assist with the general wellbeing of your total health. There still needs to be greater research of high-level quality into this area to be more conclusive and specific and definitely an area of interest that is gaining traction with more public awareness.

Understanding what low or zero sperm numbers mean for you

It’s important to note, if your sperm numbers may not be the ideal, unless your sperm numbers are zero, it is still certainly possible to be able to achieve a pregnancy.

With the advances of assisted reproductive technology/ IVF, especially ICSI where a single good-looking sperm is selected and directly fertilised with a developing egg, this process can bypass to some degree the necessity to have the ‘best numbers’.

If your sperm numbers are zero, then your specialist/andrologist will need to do further testing +/- biopsy to find the cause and manage appropriately if possible.

In about 1% of the male population, and a 10-15% of the men deemed infertile, there is azoospermia or zero production of sperm; in which some of these are treatable and some unfortunately not (11).

Where to now? Spread the word!

Okay, so now you know a little bit more about men’s fertility, please spread the word. The more we start talking about infertility in men and women, the more proactive we can be to find the answers and work on the best possible chances and outcomes for you.

Don’t know where to start? That’s okay. Pop in for a consult and we can work with you to help guide the way and point you in the right direction.

Want to know more about fertility? Have a read of one of my previous blogs here about ways to boost your fertility health.

If you’re interested in booking an individualised assessment to help your fertility health, D r Karen Chan (Acu) and Dr Voula Te p (Acu) are available for consult. Got questions? Feel free to comment below or contact us for further information. Hope to see you in the clinic soon, healthy regards, Karen.

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Dr Karen Chan (Acu) is the chief Acupuncturist, Physiotherapist and Director of Prospect Physiotherapy and Health Plus Clinic in Adelaide. The clinic is an integrative clinic to address all your health and wellbeing with a holistic approach, inclusive of traditional Chinese medicine, physiotherapy, remedial massage therapy, dietetics and nutrition, podiatry, pilates, yoga and mindfulness. Having completed her Masters of Reproductive Medicine, Karen has a keen interest in fertility and stress management.

References

Farahani L, Tharakan T, Yap T, Ramsay JW, Jayasena CN, Minhas S. The semen microbiome and its impact on sperm function and male fertility: A systematic review and meta-analysis. Andrology. 2021 Jan;9(1):115-144. doi: 10.1111/andr.12886
Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, et al. EAU Working Group on Male Sexual and Reproductive Health. European association of urology guidelines on male sexual and reproductive health: 2021 Update on male infertility. Eur Urol. 2021 Nov;80(5):603-620. doi: 10.1016/j.eururo.2021.08.014
Mishra, P., Negi, M., Srivastava, M., Singh, K., & Rajender, S. (2018). Decline in seminal quality in Indian men over the last 37 years. Reproductive biology and endocrinology : RB&E, 16(1), 103. https://doi.org/10.1186/s12958-018-0425-z
Arya ST, Dibb B. The experience of infertility treatment: the male perspective. Hum Fertil (Camb). 2016 Dec;19(4):242-248. doi: 10.1080/14647273.2016.1222083
Leisegang K, Dutta S. Do lifestyle practices impede male fertility? Andrologia. 2021 Feb;53(1):e13595. doi: 10.1111/and.13595
Sharma A, Minhas S, Dhillo WS, Jayasena CN. Male infertility due to testicular disorders. J Clin Endocrinol Metab. 2021 Jan 23;106(2):e442-e459. doi: 10.1210/clinem/dgaa781
Omolaoye TS, El Shahawy O, Skosana BT, Boillat T, Loney T, du Plessis SS. The mutagenic effect of tobacco smoke on male fertility. Environ Sci Pollut Res Int. 2022 Sep;29(41):62055-62066. doi: 10.1007/s11356-021-16331-x
Kahn LG, Philippat C, Nakayama SF, Slama R, Trasande L. Endocrine-disrupting chemicals: implications for human health. Lancet Diabetes Endocrinol. 2020 Aug;8(8):703-718. doi: 10.1016/S2213-8587(20)30129-7
Rodprasert W, Toppari J, Virtanen HE. Endocrine disrupting chemicals and reproductive health in boys and men. Front Endocrinol (Lausanne). 2021 Oct 7;12:706532. doi: 10.3389/fendo.2021.706532.
Feng J, He H, Wang Y, Zhang X, Zhang X, Zhang T, Zhu M, Wu X, Zhang Y. The efficacy and mechanism of acupuncture in the treatment of male infertility: A literature review. Front Endocrinol (Lausanne). 2022 Oct 18;13:1009537. doi: 10.3389/fendo.2022.1009537
Punjani N, Kang C, Lamb DJ, Schlegel PN. Current updates and future perspectives in the evaluation of azoospermia: A systematic review. Arab J Urol. 2021 Jul 22;19(3):206-214. doi: 10.1080/2090598X.2021.1954415

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Male infertility, decreasing sperm quality — and what can help